Reimbursement & Advisory for Hospitals

Reimbursement & Advisory for Hospitals


Maximize today, anticipate tomorrow.

What strategies do you need to improve your margins and overall financial performance? What opportunities exist when you consider the market demand, regulations and demographics of the communities you serve?

Our HORNE team offers timely and relevant insights to help optimize reimbursements, protect margins and identify the best opportunities for growth. We evaluate your unique environment and look at the competitive forces to provide financial impact analyses to reveal the best strategies going forward.

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Take advantage of our broad range of Reimbursement and Advisory solutions.

Revenue Advisory
As fee-for-service reimbursements flatten out, you will need to project revenues under new payment models and identify new sources of revenue. Knowing your payer mix is just the beginning. You must go deeper to examine how you use capital to generate return on investment and fulfill your mission.

We help you evaluate factors such as market demand for new services, as well as the cost and life span of the technology required to meet that demand. We deliver recommendations designed to boost revenues and improve your overall financial strength, while minimizing risk and exposure.

Medicare and Medicaid Cost Reports
When preparing your report, we focus on optimizing reimbursements to protect your revenue streams from exposure to regulatory sanctions and denials. We review and analyze the trends within the reports for opportunities to enhance revenue and position your organization for success today and in the future. In cases where appeals are warranted, we can expedite and assist in filing.

Medicare Low Volume Adjustments
Sole Community Hospitals (SCH) and Medicare Dependent Hospitals (MDH) qualify for additional payments based on Medicare low-volume adjustments. If reduced payments or increased patient volumes impact your business, we can assist you in the application process. Our goal is to help you cover fixed costs and gain your fair share of reimbursements.

Special Hospital Designations
Together, we can evaluate whether you qualify as a Disproportionate Share Hospital, Critical Access Hospital or Sole Community Hospital. Your designation can significantly impact reimbursements and, ultimately, your bottom line. We help you with the details of applying for designation, leveraging our deep knowledge and experience with the Medicare system.

Community Health Needs Assessments
The Community Health Needs Assessment (CHNA) can be more than a regulatory requirement. We help you leverage insights gained to create a road map for your organization’s mission — and engage community partners who share a stake in that mission. Together, we can conduct a CHNA that meets regulatory guidelines, identifies community needs and creates community involvement and awareness.

Medicare Geographic Classifications
Your geographic classification impacts both your wage index and your Medicare reimbursements. Our team can help you appropriately adjust your classification to ensure you’re receiving the correct payment amounts. We review the required criteria and guide you through the next steps and even help file your application.

Wage Index Review and Occupational Mix Surveys
The occupational mix survey by the Centers for Medicare and Medicaid Services (CMS) directly impacts your wage index reviews. These complex surveys require an analytical and strategic approach to ensure data is accurate and consistent. By preparing and reviewing these surveys, we can ensure your reimbursement rates are at optimal levels.

Supplemental Payment Optimization
Precisely how much of the care you provide is currently uncompensated? By identifying errors in documents, methodology and coding, we can help you spot uncompensated care costs and apply for supplemental Medicaid reimbursements. Additionally, we explore supplemental funds that are available in your state (such as improving patient access) and help you find innovative ways to get the fair and full compensation for the care you deliver.